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Managing Editor,Angela Maas,reported today about the physician studies that successfully revealed the ability of robust EMRs to accurately predict the consequences of cancer regimens on health.

Studies led by physicians affiliated with US Oncology show that robust electronic medical records (EMRs) can accurately predict the health outcomes of cancer regimens. The results, which were presented at recent conferences, open the door to researchers asking about more nuanced issues, allowing them to really drill down on which therapies may be most appropriate in specific patient populations. Such results could aid health plans in their attempts to ensure providers adhere to evidence-based guidelines.

According to Eric Nadler, M.D., medical oncologist at Texas Oncology – Baylor Sammons Cancer Center and medical director of Healthcare Informatics, a US Oncology subsidiary,“there are not a lot of systems in the U.S. where there is clinical, cost and utilization data all in one source.…There are very few places where coding is robust in every capture point.”

But with the data captured by some EMRs, such as US Oncology’s iKnowMed, used in these studies, “we can ask clinically meaningful questions as simple research questions and get an answer in terms of health outcomes, progression-free survival and overall survival,” he explains.

One study, which examined the clinical outcomes of second-line monotherapy in people with advanced non-small cell lung cancer, looked at Tarceva (erlotinib), Taxotere (docetaxel) and Alimta (pemetrexed). Treatment duration, progression-free survival and overall survival were tracked.

In the second-line setting, “all of the therapies seem to be fairly equivalent” in progression-free and overall survival, says Nadler. Alimta is the most costly “by nearly a factor of two,” he says. Tarceva is “difficult to compare because it’s oral, so it has its own challenges.” A patient, he points out, “can write off a copay if they’re in a clinic, but they can’t at a pharmacy.” And “Taxotere will be generic soon.”

Study Results Mirrored Earlier Ones

But, he says, the study was focused on “proof of concept” more than anything else — “we knew the answer before we did the study,” he says.“This echoed what we already knew.”

“The biggest thing is that this opens up a research channel opportunity where we can ask similar questions,” such as outcomes for people older than 70 or older than 80, he says.“We can ask more nuanced questions.”

Another study examined patterns of care and survival in second-line pancreatic cancer treatments. Xeloda (capecitabine) or fluorouracil as a monotherapy, a Xeloda- or fluorouracil-based combination, Gemzar (gemcitabine) plus Tarceva (erlotinib), a Gemzar-based combination and other therapies were studied.

Limited data show there may be some survival benefit for patients receiving second-line therapy, but “there doesn’t seem to be any standard” regimen, says J. Russell Hoverman, M.D., Ph.D., medical oncologist with Texas Oncology and medical director of US Oncology subsidiary Innovent Oncology.

The median overall survival for patients who received second-line therapy was 52 weeks versus 25 weeks for those who didn’t. But because only a limited number of the patients studied received second-line therapy, more studies are needed to come to definitive conclusions, Hoverman says.

“I think this is the first flurry of studies” to answer clinical questions by looking at the iKnowMed database, he says. He adds that an expanded study of the pancreatic cancer data is possible, as this study “was the first cut at it.…We may look at the same data in a different way.”

For health plans, says Hoverman, costs for many oncology regimens can be substantial, and there can be quite a bit of variation among some therapies. Although with retrospective studies, researchers must “be careful that they’re looking at apples to apples,” health plans can use data from credible studies to make sure patients are getting appropriate treatment, he explains.